PZI
PZI veterinary insulins are intermediate-acting to long-acting, and can be closer in molecular structure to a cat or dog's own insulin than human-type or analog insulins. PZI is rarely used in dogs but is considered when other insulins are not effectiveSelecting an Insulin for Treatment of Diabetes Mellitus in Dogs 7 Cats-Page 40. Antech Diagnostics' newsletterAntech Diagnostics Newsletter: Hard to Regulate Cats & PZI mentions a JAVMA 2001 studyJAVMA 2001: PZI & Hard to Regulate Cats in which 75% of previously treated hard-to-regulate cats did well with the insulin. It went on to say that most cats do require PZI twice daily. The other 25% of tested cats did not reach peak with PZI insulin until 9 hours + after injection; they would likely be able to use only one shot per day. As the study illustrates, absorption, peak and duration of PZI is variable. Various types of veterinary insulins are known as PZI, "Protamine Zinc Insulin" . The ones we use most often for animals are a combination pork/beef-derived insulin or a beef-derived insulin. Because most are veterinary insulins, PZIs are not available at normal human pharmacies. The only PZI insulin still available for people is CP Pharma's Hypurin Bovine Protamine Zinc and it must be imported from the UK. PZI itself was introduced in 1936; it was the first insulin having any type of suspension. Before PZI, the only insulin available was R/Neutral, having no additives to alter or extend its action. Until then, many with diabetes had to get up during the night to take an insulin injection because R/Neutral did not last long enough for an uninterrupted night's sleepSome Rules for Dosage of Protamine Zinc Insulin-Canadian Medical Journal-1938 . Technical details PZI contains more zinc and protamine than NPH/isophane insulin and it is primarily the extra protamine which gives it its long-acting duration. The additional protamine in the suspensionPZI Insulin--More Protamine Than NPH/Isophane Insulin must first be broken down by proteolytic enzymes AKA proteasesWikipedia:Proteolytic Enzymes, before the insulin in PZI can be absorbed. NPH/isophane insulin contains less protamine than PZI does and because there's less, it is an intermediate-acting insulin. Types of Veterinary PZI PZI Vet (IDEXX) PZI Vet is made by IDEXX Laboratories (formerly Blue Ridge). PZI Vet is a beef/pork PZI insulin commonly used in diabetic cats in the U.S. Some compounding pharmacies may refer to their PZI insulins as PZI Vet, but you aren't using PZI VetIDEXX Wesbite-PZI Vet unless it is made by IDEXX Labs. Unlike the other PZI's below, PZI Vet is a mix of beef and pork insulin. Beef insulin is closest to a cat's own insulin, and pork is identical to a dog's. PZI Vet is a manufactured insulin; the formula is that of Lilly's 90% beef/ 10% pork Iletin I Protamine Zinc insulin; Blue Ridge purchased it from Eli Lilly after the firm discontinued it. BCP PZI BCP PZI is a bovine-origin PZI-based insulin. Because it's beef based, its amino acid chain is almost the same as that of a cat, so it's especially well-matched to cats. BCP Veterinary PharmacyBCP Veterinary Pharmacy Website in Houston, TX, USA, manufactures and is the sole source supplier for BCP PZI. BCP PZI is commonly used in diabetic cats in the U.S. BCP PZI is a compounded insulin. VPOA PZI All-Beef 40U PZI insulin is available from Veterinary Pharmacies of America in Houston, Texas, a source recommended by Dr. E. Hodgkins.Sources of PZI in various countries, collected by Rebecca Price of FDMB BCP, VPOA, and other compounding pharmacies are the only US source for pure beef insulin of any type. Manufactured beef insulins must be imported from CP Pharma. Insuvet PZI Insuvet Protamine Zinc or Insuvet PZI is a PZI from Insuvet, similar to BCP's PZI above. Insuvet also makes two other veterinary insulins. Schering-Plough Animal Health contracts CP Pharma to produce its Insuvet line of bovine insulinsSPAH Contracts CP/Wockhardt UK for Insuvet Insulins. Some UK pet pharmacies offer both the Insuvet-branded and the Hypurin-branded insulins. The only difference here may be pricing. Insuvet insulins are only available in the UK; the option for those in other countries is either importing from CP Pharma or, if you are in North America, the compounded PZI in various strengths available from BCP and VPOA (US) and Summit (Canada). CP Pharma Hypurin Bovine Protamine Zinc is a U100 100% bovine PZI manufactured by CP Pharma. It is approved for use in humans and can be imported into the US and other countries. CP Pharma also produces Hypurin Vet Protamine Zinc, which is pure beef but not offered outside of the UK. Those CP Pharma insulins are comparable to Insuvet Protamine Zinc, made by Schering-Plough Animal Health, a U100, 100% bovine PZI for veterinary use that is only available in the UK. CP Pharma actually produces the Schering-Plough Animal Health Insuvet insulinsCP Wockhardt UK-Producer of Insuvet Insulin Line for SPAH. UK, Canada, and US Compounded PZIs With the exception of BCP, VPOA and Summit PZI, the rest of the above are manufactured, not compounded, insulins. This means the insulin keeps longer, and is less likely to vary, as compounded insulins can, from batch to batch. The manufactured insulins have a shelf life of three years (unopened). Those in Canada can obtain 100% beef compounded PZI in U100 strength from Summit Veterinary Pharmacy Summit Veterinary Pharmacy Website in Ontario. Summit sells their insulin solely through vets--yours will need to place the order for you. Summit's insulin is comparable to BCP's U100 strength all-beef PZI, Insuvet Protamine Zinc, and the Hypurin Bovine Protamine Zinc and Hypurin Vet Protamine Zinc insulins of CP Pharma. Your vet may also be able to obtain manufactured beef insulin from the UK for you through Health Canada's Emergency Drug Release programHealth Canada-Veterinary: Emergency Drug Release Information. With it, you are able to receive up to 6 months worth of insulin; a C$ 50.00 fee for the application is required Health Canada-Emergency Drug Release Form. If permitted, you would then be eligible to import PZI insulins such as PZI Vet,Insuvet Protamine Zinc, Hypurin Vet Protamine Zinc, or Hypurin Bovine Protamine Zinc, as well as the other insulins Insuvet and CP Pharma produce. The program is similar to Health Canada's Special Access Programme Health Canada-Special Access Programme for importing necessary drugs for people. There are also pharmacies in the US and UK that compound PZI based on human ("regular") or animal-source insulins. This linkFelinediabetes.com--PZI Sources and this onePetdiabetes.org--PZI Source List list some of those compounding pharmacies, their contact information, and prices for their insulins. Handling and use According to MerckMerck-Excess Protamine Prohibits Same-Syringe Mixing of Protamine Zinc Insulins, in cases where a shorter-acting insulin is needed in addition to the PZI, the protamine zinc insulin must always be injected separately--'NO mixing'--due to the excess of protamine in the insulin formulaComparison of Injection Techniques for Soluble and Protamine Zinc Insulins in Diabetes Mellitus PubMed-Practitioner-1975British National Formulary (BNF)-Protamine Zinc Insulin Binds With Soluble (R/Neutral) in Same Syringe. Specifications of PZI British National Formulary defines protamine zinc insulin as a sterile suspension of insulin in the form of a complex obtained by the addition of a suitable protamine and zinc chloride. British Pharmacoepia (BP) and United States Pharmacoepia (USP) definitionsBritish National Formulary Protamine Zinc InsulinBritish Pharmacoepia & United States Pharmacoepia Protamine Zinc Insulin Defined: Protamine Zinc Insulin Sterile buffered suspension of mammalian insulin to which protamine and zinc chloride are added. White suspension. pH 6.9 - 7.5 iso-osmotic with blood. Contains for each 100 units of insulin, 1 - 1.7 mg of protamine sulphate and zinc chloride equivalent to 200 per g of zinc, 10 - 11 mg of sodium phosphate. Protamine Zinc Insulin Buffered sterile suspension to which zinc chloride and protamine sulphate are added. 40, 80, 100 units/ml. Also contain glycerol, cresol, phenol, sodium phosphate for each 100 units of insulin in addition to protamine and zinc. Cases on this wiki Click the main category or one of the subcategories below to see cats and dogs using each insulin, or who have used it in past. *All PZI cases *Category:PZI Vet cases *Category:BCP PZI cases *Category:Insuvet PZI cases *Category:Hypurin Vet PZI cases *Category:Compounded PZI cases Further Reading *Insulin Therapy in Cats With Diabetes Mellitus-JAVMA-1983 Contains peak, onset, duration data for NPH/isophane & PZI insulins in cats. *Comparison of 2 Ultralente Insulin Preparations With Protamine Zinc Insulin in Normal Cats-American Journal of Veterinary Research-1994 *Absorption Kinetics of Regular (Neutral), Isophane (NPH) and Protamine Zinc Insulin (PZI) in Normal Cats-Domestic Animal Endocrinology-1990 *Insulin Therapy in Cats with Diabetes Mellitus-JAVMA-1983 Some feline Time Activity information on NPH/isophane & PZI insulins. *List of sources and prices for PZI insulins worldwide *BCP Contact information *British National FormularyAccess to BNF is free but you must register and log in to use it. *Characteristics of Animal Insulins *Protamine Zinc insulin information--InChem *Some Rules for Dosage of Protamine Zinc Insulin-Canadian Medical Association Journal 1938 This dates back to 2 years after PZI was introduced. Though these are human experiences, it may provide some insight into using pure beef PZI. "Unmodified Insulin" referred to is today's R/Neutral type. References Category:InsulinsCategory:long-actingCategory:intermediate-acting Category:Terms Category:VeterinaryCategory:BovineCategory:PorcineCategory:Rx Status